Factors associated with yearly fluctuations in mild neurocognitive disorder status among older primary care patients

Research Objectives: While cognitive assessment is included in the Medicare annual wellness visit, fluctuation of cognitive status among older adults in a yearly basis has not been investigated. The objective of this study was to identify characteristics and risk factors associated with the fluctuation of cognitive status.

Design: Prospective longitudinal cohort study.

Setting: Primary care patients in Boston MA area communities.

Participants: This study included 258 participants (mean age 76) from the Boston Rehabilitative Impairment Study of the Elderly (Boston RISE), who completed neuropsychological testing, physical performance testing, and questionnaires at baseline to 2-year follow-up.

Interventions: NA

Main Outcome Measures: Participants were categorized into four groups based on their yearly cognitive status (cognitively normal or mild Neurocognitive Disorder (mNCD)). Repeated measures multinomial regression analysis was used to examine the differences between the cognitive groups and associated characteristics.

Results: Fifty-five percent of participants were persistently cognitively normal, 14% were persistently mNCD, and 31% of participants fluctuated in their cognitive status over 2 years of follow-up. Better mobility (Short Physical Performance Battery (Relative Risk Reduction: 0.73), greater physical activity (RRR: 0.97), and higher level of education (RRR: 0.46) were associated with risk reduction and increase in depression score (RRR: 1.11) and non-white race (RRR: 3.57) were associated with greater risk of being classified into the persistently mNCD compared to cognitively normal.

Conclusions: We observed variability across change in cognitive status over time. We observed modifiable and non-modifiable risk factors associated with fluctuating and persistently mNCD groups. This study reinforces the potential benefit of multifaceted exercise treatment for preventing and treating older adults with fluctuating cognition.

Author(s) Disclosures: The authors declare no conflict of interest.